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Into madness: Geschichten vom Verrücktwerden

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Simultaneously a memoir, a series of case-studies, a confession and a hall of mirrors, A K Benjamin’s Let Me Not Be Mad takes the reader on a twisting psychological journey through madness, love and self-destruction.

A room with two people in it. One of them is talking, the other is listening. Both of them need help.

Written from a uniquely affecting and involved perspective, this is a story that begins somewhere familiar – the consulting room – but ends somewhere utterly unexpected.

Through a series of intense encounters with minds on the brink, it shows how fine the line is between strange behaviour and catastrophic illness, between truth and fantasy. Then it shows what it’s like to cross that line, leaving a trail of destruction in one’s wake.

It is a book about confronting the truth of who we are and what we have done. But it’s also about confronting the darkness in us all, driving millions of us to distraction and collapse.

In pursuit of its author’s secrets, you will be led through a hall of mirrors; a labyrinth of stories that pin you with their energy and emotion.

Along the way, you will discover that all too often madness, like beauty, is in the eye of the beholder.

Hardcover

First published February 14, 2019

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A.K. Benjamin

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5 stars
103 (22%)
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116 (25%)
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133 (29%)
2 stars
75 (16%)
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21 (4%)
Displaying 1 - 30 of 93 reviews
Profile Image for CanadianReader.
1,306 reviews185 followers
March 2, 2019
A.K. Benjamin’s Let Me Not Be Mad is a fascinating hybrid of a book. In part a collection of case studies of patients with neurological problems, it is also a rather slippery memoir, an exploration of the doctor-patient relationship, and a critique of Britain’s National Health System. Intense, ironic, sharply observed, allusive, erudite and (in places) possibly pseudo-scholarly*, the book demands a lot from the reader. This is particularly the case in its final third, where the narrator/memoirist, the pseudonymous A.K. Benjamin, is himself in psychological free fall. Up to this point, the reader knows “Dr. Benjamin” as a trustworthy medical professional. A neuropsychologist apparently employed in the general neurology department of a hospital in northern England, he has described his work gathering patients’ stories and testing those whose brains aren’t functioning properly for a variety of reasons—dementia, epilepsy, traumatic brain injury, motor neurone disease, and mental illness.

Dr. Benjamin comes across as a capable, deeply empathic diagnostician—though one whose approach to his work has seemingly been idiosyncratic and unconventional. (He meets patients for coffee and does non-pencil-and-paper diagnostics—in soccer stadiums, for example.) However, in the last part of the book the reader’s impression of Benjamin is largely undone by details of a mind and a life spinning out of control. In disorganized and at times incomprehensible prose, the memoirist presents himself as a person who is as troubled as any of his patients, running for years from a diagnosis he didn’t want to accept and for which he refused treatment. He reveals that some of the case studies he described are not based on patients but on himself and his own psychiatric history. The most notable of these cases concerns “B”, the young son of dysfunctional, psychologically “absent” parents, a boy known to leap from bedroom windows and shock himself using a model train set.

Given these later revelations, it’s not surprising, really, that one of the earliest cases Benjamin presents is that of a recently retired and widowed woman whose memory is failing. “Lucy” has recently been found in the wrong house, watering a neighbour’s houseplants. On another occasion, she forgot to turn off a tap before answering the phone and flooded her home. Her semantic memory (recall of facts) is receding, and her speech is odd: similar sounding words are spoken in place of the right ones. Based on her clinical presentation and her MRI scan, she’s diagnosed with early onset dementia, but a few months later when the scan is repeated, the abnormality (hypoperfusion of brain tissue) which led to her catastrophic medical labelling is no longer in evidence. The neurologist overseeing the case is forced to walk back the diagnosis. Lucy’s behaviour is now to be viewed as an extreme response to bereavement and significant life changes. Too late. She has accepted the initial verdict and begun the descent into actual dementia.

Benjamin explores a study of the ways in which input from medical professionals can drastically alter (read: limit) patients’ perceptions of themselves and their capacities. His awareness of such studies may explain in part his own resistance to a diagnosis when he was a younger person. Ultimately, however, his dysfunction catches up with him. His professional approach can no longer be written off as that of a maverick. It is clear that his behaviour is abnormal and his judgement dangerously compromised. He is mad.

For the most part, I found Benjamin’s book a fascinating one. The mind behind it, if disordered, is nimble and capacious. There are innumerable literary, neurological, psychological, and pop culture references, not all of which I comprehended. I suspect if I reviewed this book on a different day, I would highlight different sections and might even draw different conclusions about it. That’s how rich and stimulating it is. I do wish the last section, which deals with the author’s madness, had been more controlled. I suspect Benjamin wanted to communicate the degree to which his mind had unravelled. However, I’m not sure that forcing the reader to wade through so much muck and mess is necessary to get the point across.

I would like to thank Net Galley and Penguin Group/Dutton for providing me with a digital copy of this intense and challenging puzzle of a book.

Rating: 3.5–rounded up.

* I checked some parenthetically noted “scholars” and dates and couldn’t find the studies being cited.
Profile Image for Joy D.
3,155 reviews336 followers
June 14, 2021
I am interested in reading about psychiatry, psychology, and mental health in general. I picked up this book thinking it was a series of case studies based on the author’s long-term neuropsychology practice. It turned out to be different than expected.

I enjoyed the first half, which provides examples of mental issues, such as declining memory, brain trauma, and epilepsy. As we get into the second half, it becomes more fragmented and less focused. There are paragraphs that are not coherent. I think, perhaps, the author is attempting to give the reader an idea of what it is like to live with mental disturbances. In my opinion, it may have worked better as fiction, where the reader may be more receptive to a creatively written, but disjointed, narrative.
Profile Image for Alexandra.
119 reviews3 followers
February 18, 2019
This book is all of wonderful, thought provoking and also very confusing.

I am still not sure I fully understand it or completely followed it - perhaps that is the point. When finished it almost feels like my mind is addled as much as the author’s - which could well be a sign of how consuming the writing is and that this is written to make your thoughts and feels echo those of the author. Really strange and interesting.
Profile Image for Beatrix.
436 reviews368 followers
February 23, 2020
In 'Laat me toch niet gek zijn' volgen we A.K. Benjamin (pseudoniem) in zijn dagelijks werk als neuropsycholoog in het contact met zijn patiënten en hun naasten. Confronterende en herkenbare voorvallen worden afgewisseld met casussen die angstiger en meer ongrijpbaar lijken te zijn zoals dementie, niet-aangeborenhersenletsel en psychoses. Maar belangrijker nog dan de uiteindelijke diagnostiek is het contact tussen de hulpverlener en de patiënt. En juist die grens dreigt steeds meer te vervagen naarmate het boek vordert. Want verwarring, waanzin en deviant gedrag is ook binnen de meest gezonde versie van onszelf in enige mate aanwezig, maar hoe verhoud je je als hulpverlener nog tot je patiënt wanneer je jezelf hierop betrapt? In hoeverre beïnvloedt dit de keuzes die je tijdens je werk maakt? En wanneer stop je met het oprekken van die grens en op welk punt is er dan reden tot ongerustheid?

Wat volgt is een verwarrend, ongrijpbaar, ironisch en persoonlijk relaas, waarin de auteur naarstig grip probeert te krijgen op juist datgene wat hij (nog) niet begrijpt uit angst dat dit hem zal ontregelen. Hiermee weet A.K. Benjamin niet alleen zijn eigen duisternis en die van zijn patiënten in woorden te vangen, maar benadrukt hij op treffende wijze hoe dichtbij deze kwetsbaarheid voor ons allemaal kan zijn. Erg indrukwekkend geschreven, gelaagd, en met een ijzersterke opbouw. Top!👌
Profile Image for Jreader.
554 reviews1 follower
July 21, 2019
I did not like this book. I read a review in the NY Times, which proclaimed it as exellcent with a write-up so compelling I was pleased to purchase it through Amazon for $16.

Rarely do I trash a book in a review. It was awful. Presumably, you--the reader-- are observing the author observe himself as his life unfolds and a degenerative condition unravels his life. The beginning of the book has a chapter per client for the reader to notice the author describe the symptoms of the patient, the difficulties of the healthcare system, the balance of trying to see the patient as human as they deteriorate. It makes the reader aware of the difficulty of neuropsychology as opposed to 'talk therapy'--no worried well here. And after about the first 6 we start to see the break down of the author, which erodes to workplace incompetence. He is sent to therapy, which seems to be absolutely no use.

Did the book make me intrigued? Not at all. Was I interested in the characters? I began to see the author as very self-serving an had no empathy for him by the end of the book. Does this kind of thing happen to people with a degenerative mental illness? Yes, it does. Is it tragic when that occurs? Yes, it is.

I did not care about the author. I flipped through the last pages. The epilogue did not disclose the diagnosis or outcome. It would have been better if I had donated the $16 to a go-fund me for his after care or for his children. It was the worst book I have read all year. I don't even want it in my bookcase. Ick. Ick. I'm tossing it into the Goodwill pile. Ick. What a waste of time. I do not recommend the book.
Profile Image for Kressel Housman.
992 reviews263 followers
September 23, 2019
The author of this book is a neurologist or psychologist, so it’s not surprising that the flap copy compares him to Oliver Sacks and R.D. Laing. Those names are guaranteed to pique my interest, and the summary also promised that there would be a prescription for a more truly empathetic therapy at the end, so I took the book out of the library without ever having heard of it before. Normally, I check everything out on Goodreads first.

The book is indeed structured like an Oliver Sacks book with chapter after chapter illustrating Dr. Benjamin’s interactions with his patients, but he doesn’t have Dr. Sacks’ tidy storytelling style and my mind wandered quite a bit. The comparison to R.D. Laing was quite apt, though, because he too is calling B.S. on himself and the whole diagnostic profession. Those were my favorite parts, so I coped down my favorite quotes. Here goes:

1. “Coy behavior begins early in development to elicit nurturance and reduce the possibility of adult aggression.”

2. “Doctors would always be the central characters in their own emergencies, the patients just extras.”

And my very favorite, written about a patient with divine delusions of himself . . .

3. “He wasn’t the first bipolar-ADHD-narcissist-addict – whatever he was – who had gone to town on his Higher Power.”

Though I’ve said this in other reviews, it applies here too: 5-star gems of wisdom amid a 3-star (sometimes boring) narrative.

The book took a dramatic and unexpected turn about three-quarters of the way though. I won’t spoil it, but I will say that it’s about the author’s personal life. The events don’t seem to be presented chronologically, so I was confused by precisely what happened to him, and I was relieved to find another Goodreader who felt the same. The last chapter was a pleasant surprise, though. It wasn’t at all the more empathetic therapy I was expecting, but I like it.

If you are interested in the practice of psychology, this book is worth checking out. But I warn you: it’s a bit experimental in its organization. It’s meant to reflect the disordered jumble of a human mind, which means the author is really showing and not telling, but if you like a more traditional narrative, you might find the book hard to get through.
27 reviews
March 17, 2019
A classic, combining science, poetry, humanity and deep introspection. True brilliance
1 review
May 3, 2019
Written in dense muscular anarchic prose, taking us deep inside the delirious fictionalised mind of its author the book has the feel of a juggernaut relentlessly plowing towards the cliff face. It’s got a truly original and utterly uncompromising feel. Occasionally you feel a bit like you’re playing catch up but it is despite its confusing feel honest , striking, and at times savagely funny. An outstanding original debut.
1 review1 follower
February 27, 2019
Unique, fresh, and whilst at times it could read Somewhat confusingly, it all becomes clear in the end. This is a special kind of story told in a special kind of way, that continues to grow on you long after you’ve closed it for the last time...
Until you inevitably open it to read it again with a whole different perspective!
1 review
May 3, 2019
As urgent and compelling as it is profound. Unmissable
3 reviews
May 3, 2019
This is an absolute cracker. Funny, dark, moving, surreal and also very real. I loved it.
Profile Image for Lies.l.
117 reviews2 followers
October 26, 2023
Da ist der Titel Programm. Lesenswert.
368 reviews1 follower
December 10, 2021
Nobody does self-loathing like a Brit.

The author is a neuro-psychologist. He has spent most of his career evaluating patients with cognitive and behavioral problems to tease out the physical or mental/emotional sources. But he, himself, is experiencing similar problems and trying to figure them out at the same time.

If you're looking for a kindly, gentle soul who admires the grit and coping effort of his patients, go look in the S Section; Sacks, Oliver. Because he sure isn't here. The author is icy and distant with the incurable and dismissive of the rest. He had disdain for his field and its practitioners, and is contemptuous of himself. He subjects everything to examination with laser-like intensity, until the object turns black and starts smoking.

Most of the book is a series of vignettes with patients. It's hard to follow, because it's British English and because it seems to jump suddenly among his patients' conditions, his own conditions, and the science of neuro-psychology.

One thing that kept me reading was his kitty-kat writing style: Purr, purr, purr... BITE! Besides being unexpected, it was often funny.
400 reviews1 follower
May 1, 2019
This is a rather strange book, but compelling. Some of his description and analysis of patients and their conditions is engrossing. I couldn't put down the first half. In the second, the language itself changes, becomes more extreme and disordered and I was disappointed to find that half the patients were aspects of his own psyche and experience. There's a point where he calls himself a doctor without boundaries and that feels spot on. So it's a disconcerting experience for teh reader though arguably it gives us a powerful sense of what a disturbed and fragmenting mind feels like. It also reminds us that doctors are in many ways as broken as their patients. There is empathy here, wisdom and humour but it is increasingly hard to identify these as the book goes on.
2,728 reviews
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October 16, 2019
I picked this up based on Parul Sehgal's enthusiastic reception of it in the NYT and on the book review podcast; it sounded really interesting. I couldn't stand this book, although I still think it's an interesting concept! The narrator and the medical events he witnesses or hears about really got under my skin in an unpleasant way, and I'll certainly admit to the power of the writing. I have a feeling if I had picked this up at a different time, I might like it quite a bit. Unexpectedly, the Britishisms really threw me, too!
1 review
May 3, 2019
Amazingly compelling book. It read it in two days and was both totally engrossed and disoriented as the stories morph from an account of fascinating clinical case studies to something more intriguing as the doctor’s own mind becomes the subject. Totally unlike anything else I’ve read. I loved it and highly recommend it.
1 review
July 13, 2019
I found this book at once terrifying and fascinating, like watching a train wreck in slow motion. You want to look away, but you cannot. You want to believe that you are not on the train, that you are not at risk of being one of the casualties, but you slowly begin to wonder if you might be.

The author deftly weaves a clever story of a clinical neuro-psychologist and his very human struggles to help, understand and show empathy for his patients while also trying to understand himself and what he fears may be his own slow fall into disease of his mind and brain. It brought to mind the Nietzsche quote, "He who fights with monsters should be careful lest he thereby becomes a monster. And if thou gaze long into an abyss, the abyss will also gaze into thee".

Be patient (no pun intended) with yourself when you read this mesmerizing account of one doctor's chess match with traumatic brain injury, disease and self-discovery; it's a bucking bronco and you might get thrown a few times. Let it soak in and re-read those sections - you will be rewarded for your efforts. I did not grasp all of the book but I got enough of it that I felt moved at the very end. If you wait out the wild ride, you will be rewarded, too. As the good doctor quotes near the end of the book, "I became weightless, an astronaut inside my own body". Captain Kirk had it wrong: space is not the final frontier; the mind and landscape of its physical container (the brain) are.
Profile Image for Luis de Castro.
4 reviews
May 3, 2019
Peculiar, daring and quite original. LMNBM never gets boring. Excellent book about the blurred lines between “ normality” and “ madness”. Very good account of a descent into the hellish kingdom of the mind.
653 reviews6 followers
February 11, 2023
Ik weet niet precies wat voor boek ik heb gelezen. Toch had ik het niet willen missen.
Profile Image for Emma.
225 reviews
March 24, 2024
Interesting read, I specifically liked the case studies, but the format was a bit too experimental for me.
501 reviews
July 4, 2019
Disturbing. Dark. Ironic. Funny. Personal essays. Sortof. A memoir of mental illness by a neuropsychologist. Sortof. A critique of the British medical system. Sortof. One of the best books I’ve read. Definitely. But definitely not linear or particularly straightforward. I loved it.
Profile Image for Peter F. Delaney.
32 reviews1 follower
June 19, 2019
Let’s begin with this: I think I came into the book with the wrong expectation. I thought the author was going to give me a tale of hope, with a miraculous recovery from mental illness, or some ways he found to live with it. This isn’t that kind of book. It’s grim, it’s hard, and it’s vivid, full of unhappy endings for unlucky people.

It’s also full of little references to other writers as he drops the Real Talk on you. Life is nasty, and brutish, but not so short. And ooh yeah, life goes on, long after the thrill of living has gone. (See what I did there?)

The author is a neuropsychologist, which is a person who assesses what kinds of cognitive deficits you have after brain damage. He spins out the greatest case study hits from his long career. It’s brain damage cases, so lots of the stories are deeply horrifying. In addition, our narrator is of the “unreliable” variety, as we learn that he’s a psych case himself. A lot of musings follow about our contemporary need to identify physical causes, when the non-physical or psychological is so often explanation enough. At its worst, the book is overwrought and sometimes a bit incoherent, but the stories stuck with me, and the author’s insights are sometimes striking. It’s definitely different from other psychologists’ books.
Profile Image for Kristina.
1,090 reviews6 followers
December 27, 2019
This was a hot mess of a book. It starts off reading as a collection of case histories from a neurologist (see Oliver Sack’s books) but quickly I had a hard time following the patients and the thread between them. Very late in the book, there is a revelation which makes the reader have to rethink what they read. It’s an idea that had the potential work brilliantly but the book was so over the place, it just wasn’t executed well and I almost abandoned.
Profile Image for Katrina.
811 reviews
April 13, 2019
This book is a trip. It left me baffled and convinced I have dementia.
Profile Image for Rachel.
589 reviews12 followers
August 5, 2019
This book has me reflecting on how much Western society celebrates certain types of madness while stigmatizing others. It's also a horror story for anyone approaching middle age (*cough*) and fearing dementia. The writer begins his narrative planting little seeds of dread by introducing his reader to the patients he's in the middle of diagnosing for various neurological disorders- unnamed but likely Alzheimer's, Parkinson's, and other pathologies that diminish cognitive function. As he reminds readers repeatedly, the disease usually begins in people's 40s- hiding out, remaining undetected for a decade or two. When it's noticeable, it's often too late to treat it.

His patients' aphasia foreshadows his own breakdown, his own loss of self and family, and, in one of the more chilling sections, the loss of a therapist meant to help him. Instead the writer turns to Iron Man competitions and meditation. Both of those interventions become extensions of his mental illness, calling into question the value of any activity that takes people to the edge and leads them further from having meaningful connection with, say, their children. The crackling pauses in the conversations he has with his children while he attends a meditation retreat at the top of the world echo the disjointed conversations he has with his patients while administering his diagnostic tests.

While the content can be a bit bleak and alien, the structure of the book is innovative and propulsive. The jacket blurbs that describe it as "gonzo journalism" and a mash-up of Oliver Sacks and Hunter S. Thompson are really misleading. It doesn't have the energy, voice, or subject matter of either of those writers. Even the title doesn't quite fit the trajectory of the narrative- the German version Into Madness seems like a better fit. Critical reviews-while largely positive- suggest that this is a book that different readers will experience in very different ways, and that this is a book that will benefit from multiple readings at different periods of life.
1 review
September 19, 2019
In the course of his near fifty years, Dr. A. K. Benjamin has proved himself a man of extremes. With a diverse and colourful series of careers, occupations and vocations ranging from screenwriter to therapist, Benedictine monk to extreme sports enthusiast, his work as a clinical neuropsychologist led him to social outreach among L.A.’s street gangs and the underprivileged in village India. But in this his first ‘novel’, what appears as a collection of conventional clinical case studies (à la Oliver Sacks) slowly reveals itself to be something quite different. The numerous portraits of the doctor’s NHS patients in the psych-ward of a London hospital are in reality facets of the doctor’s own life and mind. As the story progresses, normalcy digresses, and the goodly doctor “becomes the patient”, proves to have been the patient all along. The author confesses toward the end of his book, perhaps only half in jest, “I wrote in the hope I might create a doctor who could care for me.”

The book’s title is taken from King Lear: “O! Let me not be mad, not mad, sweet heaven; keep me in temper!” A clue to the real action of A.K. Benjamin’s account are the words of the Fool just prior to Lear’s petition: “Thou shouldst not have been old till thou hadst been wise.” The reader soon discovers that mixed in with A.K. Benjamin’s breath-taking neuropsychological vocabulary is the wit of an accomplished man of letters—a wordsmith, a novelist—who seeds his case studies in this penetrating piece of fictional non-fiction with rich literary and autobiographical references that hint at the work’s true intent.

As the pace of the narrative accelerates, readers find themselves scrambling for solid ground amidst the groans, heaves and sighs of an unsteady mind labouring to break through to a deeper self-understanding. A.K.’s abundant humour is comic relief for an otherwise serious undertaking. If neuropsychological evaluation is about getting to the root of things, A.K. endeavours to become like his patients, to achieve the “maximum level of empathy” by searching and striving alongside them. But reading on, it becomes clear that A.K.’s therapeutic empathy is actually an account of his own struggle, and he concedes at the end of the story: “Some of the patients were me, are me—Junction Box, Bede, Craig, Benjamin—at different ages, in different stages.”

In the opening credits, we learn that A.K. Benjamin is not the author’s real name. So who then is the real A.K. Benjamin? Who is this artificer, this architect and fashioner of labyrinths?

At one point in the story, the doctor refers to himself as Tom o’Bedlam, the character in King Lear who feigns madness but who in fact is the play’s hero in disguise, namely, Edgar, son of the virtuous Earl of Gloucester. Yet, to feign madness one must have wrestled with inner demons, known them intimately, otherwise how could one recreate them? Tom is in a unique position to observe without being observed, concealing himself behind his ostensible madness. Like most of the mad, Tom o’Bedlam is no one, does not have a real name (o’Bedlam is a generic moniker indicating a psychiatric patient from London’s Bethlem [Bedlam] Royal Hospital). The mother of one of A.K. Benjamin’s avatars (Ben) says of him: “No wonder he’s like he is … He didn’t even have a name”. Symmetrically, the author of Let Me Not Be Mad does not ‘even have a name’. A saying in German goes, Namen sind Schall und Rauch/ “Names are sound and smoke”. If the names and titles of medical professionals are appended with esteemed academic credentials, neuropsychologically challenged patients are identified by the raw chaos of their symptoms. Between these two, the real A.K. Benjamin can be sighted for the first time. He is the one therapeutically deploying self-diagnosis, unmasking reified self-narratives and going all out to uncover something truer in himself.

Let Me Not Be Mad is a string of short stories, vignettes, thought-streams and sound-bytes, its prose dense, witty, layered and infused. If in places the narration is indulgent, compensation lies in the sincerity that runs throughout. The book resists summation because it is itself a summation, namely, of ten thousand intimately engaged existential questions, the distillation of a lifetime of deep personal inquiry. If the manner of another Shakespearean hero is summed up this way, “Though this be madness, there is method in it,” A.K. Benjamin’s postmodern spirituality is an apophatic pruning of the comfortable illusions upon which Western conformist culture has built its fragile empire. The book’s psycho-spiritual deconstructionism is unsettling, to be sure, leaving no terra firma. And yet, coming to the end of the book, the reader feels lighter, the faculties of healthy self-scrutiny having been thoroughly rinsed and rebooted. If by the final pages we have not found out who or what we are, we are at least clearer about who and what we are not. We are not these facile self-serving fiercely clung-to definitions, images and stories we use to describe ourselves.
—Michael Highburger
Profile Image for Jo.
1 review1 follower
June 20, 2019
This is one of the most unusual books I have ever read. Initially I was engaged in the story with the author. It then all went a bit odd and wordy. There is a sense that the author is trying to hard to be clever and that detracts from the subject. All the way through the book, I felt that a very needy individual was crying out for attention. Prior to reading the book, you learn about the "twist in the tail". It was no great surprise when the psychologist reveals he is in fact some of the patients he has written about. The end of the book unveils the psychiatric history of the author, more attention seeking or I told you I was ill to past colleagues, wife and family?
This could have been a great book if it was written with a lighter touch, a trickle of humour and less focus on me, me ,me.
My personal feeling is that it is autobiographical and perhaps should have been written in that style. It certainly does not feel like a work of fiction.
I note that it is also concerning to think someone with this level of mental health issues was treating patients with mental health issues.
2/5 Dark
This entire review has been hidden because of spoilers.
Profile Image for Marianne Villanueva.
306 reviews9 followers
August 1, 2019
Raw, excoriating, uneven.

The doctor's grasp on reality seemed shaky from the start. The style is stream-of-consciousness (Interesting, I haven't encountered a doctor's memoir using this technique before).

There are powerful moments: the patient who learns how to withstand electric shocks by experimenting with a model train set. The doctor running to the hospital with his unconscious older daughter "stuffed under" his arm like "a deflated football."

What happened to the doctor at the end? I assume his mental state deteriorated to such an extent that he was fired. One of his daughters suffered from seizures (painful, because of that one anecdote of the doctor running to the hospital with her in his arms. What's also painful is his regret, his feeling that he failed them as a father: he left their mother and their home when his children were very young).

His increasing psychosis -- How do you deal with a doctor who hides under his desk? How did his colleagues "mask" it? How terrible. It must have been devastating, not just to himself.

The last pages are a rant (in diary format). Ending in a rather abrupt epilogue.
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